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General NPI Number Information
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NPI Number | 1811138142
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Entity Type | Individual
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Provider Name | GARY MCLUSKIE MSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 05/09/2011
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Provider Practice Location Address
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Address Line | 1420 N MULLAN RD SUITE L-5
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-4366
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Country | US
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Telephone | 509-499-9266
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Fax |
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Provider Business Mailing Address
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Address Line | 11218 E 43RD AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-8610
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Country | US
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Telephone | 509-499-9266
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW 60039503
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License Number State | WA
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